Current through September 21, 2024
(a) Generic drugs.
Practitioners shall prescribe generic drugs except in the following
circumstances:
(i) When a brand name drug is
medically necessary and the appropriate prior authorization criteria has been
met,
(ii) When there is not an AB
rated generic available, or
(iii)
When the brand name drug is listed on the Department's preferred drug list as
preferred instead of the generic.
(b) Quantities dispensed.
(i) Maintenance drugs.
(A) Minimum quantities. Except as provided in
subparagraph (C), maintenance drugs shall be dispensed in a quantity sufficient
for at least a one (1) month supply.
(B) Maximum quantities. Maintenance drugs
shall not be dispensed in an amount which exceeds a ninety (90) day
supply.
(C) Less than a one (1)
month supply of a maintenance drug may be dispensed to allow a client to be
stabilized on a new or adjusted maintenance drug.
(ii) Oral contraceptives. The maximum
quantity of oral contraceptive which may be dispensed is a ninety (90) day
supply.
(iii) All other drugs. The
maximum quantity dispensed for all other conditions shall be a one (1) month
supply unless the Department has designated a minimum days supply for a
specific drug that exceeds a one month supply.
(c) Days supply. A prescription's day supply
must equal the quantity of drug dispensed divided by the daily dose prescribed.
A prescription claim will be subject to subsequent recovery if:
(i) The days supply submitted is not
supported by the dosing directions as prescribed, or
(ii) The dosing directions are given as "take
as directed" and the pharmacist has not taken appropriate action to obtain and
document on the prescription the actual dosing directions given by the
practitioner.
(iii) Extra Doses.
The Department does not pre-emptively pay for extra doses in the anticipation
of lost or wasted medication.
(d) Tamper resistant prescription pads.
Prescriptions written for Medicaid clients shall be written on tamper resistant
prescription pads per Section 7002(b) of the U.S. Troop Readiness, Veterans'
Care, Katrina Recovery and Iraq Accountability Appropriations Act of 2007. The
law requires that all written, non-electronic prescriptions for Medicaid
outpatient drugs shall be executed on tamper resistant pads in order for them
to be reimbursable by the federal government. In addition to all current
Wyoming Board of Pharmacy requirements for tamper resistant prescription forms,
all prescriptions paid for by Wyoming Medicaid shall meet the following
requirements to help ensure against tampering:
(i) Written or computer printed prescriptions
shall contain all of the following characteristics:
(A) One (1) or more industry recognized
features designed to prevent unauthorized copying of a completed or blank
prescription or prescription form. In order to meet this requirement, all
written or computer printed prescriptions shall contain some type of "void" or
"illegal" pantograph that appears if the prescription is copied.
(B) One (1) or more industry recognized
features designed to prevent the erasure or modifications of information
written on the prescription by the prescriber. This requirement applies only to
prescriptions written for controlled substances. In order to meet this
requirement, all written or computer printed prescriptions shall contain:
(I) Quantity check-off boxes plus numeric
form of quantity values or alpha and numeric forms of quantity values,
and
(II) Refill indicator (circle
or check number of refills or "NR") plus numeric form of refill values or alpha
and numeric forms of refill values.
(C) One (1) or more industry recognized
features designed to prevent the use of counterfeit prescription forms. In
order to meet this requirement, all written or computer printed prescriptions
shall contain security features and descriptions listed on the front and back
of the prescription blank.
(ii) In addition to the guidance outlined
above, the tamper resistant requirement does not apply when a prescription is
communicated by the prescriber to the pharmacy electronically, verbally, or by
fax; when a managed care entity pays for the prescription; or, in most
situations, when drugs are provided in designated institutional and clinical
settings. The guidance also allows emergency fills with a non-compliant written
prescription as long as the prescriber provides a verbal, faxed, electronic, or
compliant written prescription within seventy-two (72) hours.
(iii) Audits of pharmacies may be performed
by the Department to ensure that the above requirements are being
followed.
